Health  Vol.4 No.8 , August 2012
The effectiveness and safety of thyroxine replacement therapy for children with down syndrome and subclinical or congenital hypothyroidism—A systematic review
ABSTRACT
Introduction: Down syndrome (DS) is the most common chromosomal abnormality causing mental handicap in humans. Children with DS have significant medical problems and developmental delay which are further impaired by hypothyroidism. Those clinical features are potentially improved by using thyroxine replacement therapy. Objectives: To examine the evidence of effectiveness (motor & mental development) and safety of thyroxine supplementation in the treatment of SH and CH in children with DS. Methods: Several medical data bases (MEDLINE, EMBASE, CINAHL, Cochrane, Clinical Trials Gov, Essential Evidence and Google) were searched until 20 October, 2011, for randomized control trials (RCTs) that had examined thyroxine’s effectiveness and safety in the treatment of SH or CH in children with DS. Results: There were two high quality RCTs that examined thyroxine in the treatment of CH in children with DS, and no RCTs were found to have examined the effectiveness of thyroxine for SH in children with DS. Conclusion: The RCT which met our inclusion criteria provides the reliable evidence in recommending thyroxine for the treatment of CH in children with DS which is similar to the guidelines for general population. The absence of RCTs examining the treatment of SH in Children with DS indicates the need to conduct such trials.

Cite this paper
Al-Sabban, A. , Ahmed, S. and Al-Aama, J. (2012) The effectiveness and safety of thyroxine replacement therapy for children with down syndrome and subclinical or congenital hypothyroidism—A systematic review. Health, 4, 452-456. doi: 10.4236/health.2012.48072.
References
[1]   Tu¨ysu¨z, B. and Beker, D.B. (2001) Thyroid dysfunction in children with Down’s syndrome. Acta P?diatrica, 90, 1389-1393.

[2]   Loudon, M.M., Day, R.E. and Duke, E.M. (1985) Thyroid dysfunction in Down’s syndrome. Archives of Disease in Childhood, 60, 1149-1951. doi:10.1136/adc.60.12.1149

[3]   Nuvarte, S. (2007) Hypothyroidism in children: Diagnosis and treatment. Journal of Pediatrics, 83, S209-S216.

[4]   King, S.L., Ladda, R.L. and Kulin, H.E. (1978) Hypothyroidism in an infant with Down’s syndrome. American Journal of Diseases of Children, 132, 96-97.

[5]   Quinn, M.W. (1980) Down’s syndrome and hypothyroidism. Irish Journal of Medical Science, 1, 19-22. doi:10.1007/BF02939103

[6]   Verma, I.C. and Ghal, O.P. (1971) Hypothyroidism in children with mongolism. Indian Journal of Pediatrics, 38, 229-232. doi:10.1007/BF02823658

[7]   Brabant, G., Beck-Peccoz, P., Jarzab, B., Laurberg, P., Orgiazzi, J. and Szabolcs, I. (2006) Is there a need to redefine the upper normal limit of TSH? European Journal of Endocrinology, 154, 633-637. doi:10.1530/eje.1.02136

[8]   Aronson, R., Ehrlich, R.M., Bailey, J.D. and Rovet, J.F. (1990) Growth in children with congenital hypothyroidism detected by neonatal screening. Journal of Pediatrics, 116, 33-37. doi:10.1016/S0022-3476(05)81641-5

[9]   Grant, D.B. (1994) Growth in early treated congenital hypothyroidism. Archives of Disease in Childhood, 70, 464-468. doi:10.1136/adc.70.6.464

[10]   Glorieux, J., Dussault, J.H., Morisette, J., Desjardins, M., Letarte, J. and Guyda, H. (1985) Follow-up at ages 5 and 7 years on mental development with hypothyroidism detected by Quebec screening program. Journal of Pediatrics, 107, 913-915. doi:10.1016/S0022-3476(85)80187-6

[11]   Rovet, J.F., Ehrlich, R.M. and Sorbara, D.L. (1987) Intellectual outcome in children with fetal hypothyroidism. Journal of Pediatrics, 110, 700-704. doi:10.1016/S0022-3476(87)80005-7

[12]   Jadad, A.R., Moore, R.A., Carroll, D., et al. (1996) Assessing the quality of reports of randomized clinical trials: Is blinding necessary? Controlled Clinical Trials, 17, 1-12. doi:10.1016/0197-2456(95)00134-4

[13]   van Trotsenburg, A.S.P., et al. (2006) Median nerve conduction velocity and central conduction time measured with somatosensory evoked potentials in thyroxinetreated infants with down syndrome. Pediatrics, 118, e825-e832. doi:10.1542/peds.2006-0324

[14]   van Trotsenburg, A.S.P., et al. (2005) The effect of thyroxine treatment started in the neonatal period on development and growth of two-year-old down syndrome children: A randomized clinical trial. The Journal of Clinical Endocrinology & Metabolism, 90, 3304-3311. doi:10.1210/jc.2005-0130

[15]   Uzzan, B., et al. (1996) Effects on bone mass of longterm treatment with thyroid hormones: A meta-analysis. The Journal of Clinical Endocrinology & Metabolism, 81, 4278-4289. doi:10.1210/jc.81.12.4278

[16]   Faber, J. and Galloe, A.M. (1994) Changes in bone mass during prolonged subclinical hyperthyroidism due to Lthyroxine treatment: A meta-analysis. European Journal of Endocrinology, 130, 350-356. doi:10.1530/eje.0.1300350

[17]   Sawin, C.T., et al. (1994) Low serum thyrotropin concentrations as a risk factor for a trial fibrillation in older persons. The New England Journal of Medicine, 331, 1249-1252. doi:10.1056/NEJM199411103311901

[18]   Tirosh, E., Taub, Y. and Scher, A. (1989) Short-term efficacy of thyroid hormone supplementation for patients with Down syndrome and low borderline thyroid function. American Journal of Mental Retardation, 93, 652-656.

[19]   Biondi, B. and Cooper, D.S. (2008) The clinical significance of subclinical thyroid dysfunction. Endocrine Reviews, 29, 76. doi:10.1210/er.2006-0043

[20]   Toscano, E., Pacileo, G., Limongelli, G., Verrengia, M., Di, M., Di, M., Salerno, M., Del Giudice, E., Caniello, B., Calabro, R. and Andria, G. (2003) Subclinical hypothyroidism and Down’s syndrome; studies on myocardial structure and function. Archives of Disease in Childhood, 88, 1005-1008. doi:10.1136/adc.88.11.1005

[21]   Karlsson, B., Gustafsson, J., Hedov, G., Ivarsson, S.A. and Anneren, G. (1998) Thyroid dysfunctio n in Down’s syndrome: Relation to age and thyroi d autoimmunity. Archives of Disease in Childhood, 79, 242-245. doi:10.1136/adc.79.3.242

[22]   Van Trotsenburg, A.S.P., et al. (2002) Lower neonatal screening thyroxine concentrations in Down syndrome newborns. The Journal of Clinical Endocrinology & Metabolism, 88, 1512-1515. doi:10.1210/jc.2002-021303

[23]   Cetinkaya, E., Aslan, A., Vidinlisan, S. and Ocal, G. (2003) Height improvement by L-thyroxine treatment in subclinical hypothyroidism. Pediatrics International, 45, 534-537. doi:10.1046/j.1442-200X.2003.01786.x

 
 
Top